Capsule Enteroscopy (CE) is a fundamentally new method in diagnostic endoscopy. However, there are several factors influencing the quality of this procedure, including impermeable fluids, food remains etc. The aim of the study was to assess one of the most popular currently used bowel preparation methods and evaluate possible effects of various factors. 136 CE examinations were analysed. Each patient was prepared using 2 litres of polyethylene glycol (PEG) one day prior to examination. There was a special form filled in for each patient, which included relevant parameters (anamnesis, CE data etc.). Of 136 CE cases, 84 (61.8%) were female patients and 52 (38.2%) were male. The small bowel (SB) transit time in 112 patients varied from 39 to 502 minutes, but in 24 cases the capsule did not reach caecum. The degree of bowel cleanliness was as follows: very good — 30 (22.1%) patients, satisfactory — 97 (71.3%), and poor — 9 (6.6%). A positive correlation was observed between the degree of SB cleanliness and the SB transit time (p = 0.015). A longer SB transits time was associated with poor SB cleanliness. The results obtained in this study showed that the quality of SB cleanliness is affected by SB transit time. A relatively large percentage of cases rated as satisfactory bowel cleanliness and comparatively small percentage of bowel cleanliness cases rated as “very good” were observed when 2 litres of PEG were used prior to CE, indicating an important issues in preparation of the bowel prior to CE.
We report a case of Dunbar syndrome, May–Thurner syndrome and Nutcracker syndrome diagnosed in one patient with clinical presentation and imaging findings on Doppler ultrasonography. Dunbar syndrome or truncus coeliacus compression syndrome is an under-diagnosed vascular compression syndrome with a lot of controversy around it because of insufficient differentiation from celiac artery stenosis. May–Thurner syndrome or iliac vein compression syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression by the right common iliac artery as it crosses the iliac vein anteriorly. In Nutcracker syndrome due to compression the outflow from the left renal vein into the inferior vena cava is obstructed. The combination of all these syndromes in one patient was not described before.
Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.
The article discusses the possible relationships between intestinal microbiota and the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in inflammatory bowel diseases. Intestinal microbiota may be involved in 5-ASA enzymatic biotransformation, but the metabolism of drugs by the intestinal microbiota has been studied in less detail, and little is known about the relationships between anti-inflammatory efficacy of 5-ASA with bacterial viability, quantity and activity. It remains unclear whether 5-ASA affects the microbiota depending on the different segments of gastrointestinal tract. Drugs and diet can both improve and worsen the composition of the intestinal microbiota. However, it is not known whether drugs affect the intestinal microbiota regardless of diet. Further research is needed to answer these questions.
Liver cirrhosis is the end stage of chronic liver diseases. The current gold standard for diagnosing this condition, liver biopsy, has too many drawbacks, and research for better alternatives is ongoing. One major diagnostic arsenal includes various serological composition scores or so-called formulas. They are constantly being validated for development of new formulas. In our retrospective study of 215 patients case files who had confirmed cirrhosis of various etiologies, we examined the sensitivity and set new cut-offs for five of the most well-documented formulas. Data was obtained from the Rīga East University Hospital from 2012 to 2017 and analysed using SPSS V.22.00. In our study we found that FIB-4 at cut-off > 1.45 had over 95% sensitivity for excluding advanced fibrosis regardless of cirrhosis etiology. None of evaluated formulas had high sensitivity for detecting cirrhosis of alcohol etiology. For the viral hepatitis C genesis group, the best choice was deRitis index with almost 90% sensitivity. FIB-4 at cut-off > 2.75 was the best choice for the combined alcohol and viral hepatitis C group; BONACINI at score 8+ and FIB-4 at > 3.25 were the most sensitive in the main group containing all patients irrespective of cirrhosis etiology.
The present study evaluated the in vitro extraction of benzo[a]pyrene (BaP) from moist snuff into water and into artificial saliva. A similar, previous study evaluated the levels of BaP that remained in the moist snuff after the extraction but did not measure the levels of BaP in the water or saliva extract. The previous study showed that the remaining levels of BaP in the solid material were between 96.3% and 109.6% relative to the initial level of BaP, when the snuff was washed with water and between 99.4% and 108.3% from the initial level of BaP, when the snuff was washed with both saliva and water. Nine moist snuff samples (eight being the same brands as evaluated in the previous study) were analyzed in the present study. Several improvements were made compared to the previous study regarding the extraction conditions. The extraction was performed for 1 h at 37 °C, using a mechanical agitator.
The previous study used a commercially available artificial saliva which had an adjusted pH but did not contain enzymes or salts. This saliva was replaced with complete artificial saliva containing salts, mucin and enzymes. The results indicated that the level of BaP extracted in 100 mL water from 5 g of moist snuff at 37 °C ranged between 1.0% and 1.7% of the initial level present in tobacco. For artificial saliva, the extracted level of BaP was between 2% and 3.9% from the initial level, depending on the moist snuff brand. Although the BaP level extracted from the moist snuff with artificial saliva remained very low, the surfactant character of artificial saliva increased BaP extraction relative to water by a factor of approximately two. This study supports the previous reported finding that the vast majority of BaP in moist snuff is not extracted in water or artificial saliva. [Beitr. Tabakforsch. Int. 29 (2020) 21–26]
A diffusion denuder apparatus has been used to investigate the gas-particle partitioning of formaldehyde, acetaldehyde, acrolein and crotonaldehyde in cigarette mainstream smoke (MS), compounds that are of interest owing to their toxicity and near quantitative retention in the body during cigarette smoking. Formaldehyde showed the best performance in denuder experiments with simple aldehyde-air mixtures owing to the relatively fast rate of the heterogeneous reaction formaldehyde(g) + dinitrophenylhydrazine(s) 6 hydrazone(s). Analysis with the GORMLEY-KENNEDY equation revealed that formaldehyde denuder removal approached, but did not attain, complete efficiency even under optimized operational conditions. Acetaldehyde, acrolein and crotonaldehyde were trapped with considerably lower efficiency than formaldehyde under the denuder conditions used, and more effective denuder wall coatings would be required to examine gas-particle partitioning of these other carbonyls. The proportion of form-aldehyde in the smoke particulate phase initially entering the denuder was > 99%, but loss of formaldehyde from the smoke particles was relatively rapid leading to 35%–61% deposition over the denuder length. The temperature dependence of formaldehyde deposition in the denuder was well predicted using Henry’s law constant for aqueous formaldehyde solutions. These observed properties of form-aldehyde are primarily due to reversible reactions of formaldehyde with water in cigarette smoke leading to the much less volatile species methanediol, its oligomers and hydrate. These data suggest that cigarette smoke inhalation is likely to expose the deeper-lung generations of smokers to greater relative formaldehyde exposure, and greater genotoxic risk at those generations than might occur through inhalation of formaldehyde vapour alone.
Risk assessments of formaldehyde in cigarette smoke should be updated to recognise this modified risk profile. [Beitr. Tabakforsch. Int. 29 (2020) 2–20]
Inflammatory bowel disease (IBD) is a chronic, relapsing–remitting, inflammatory condition of the gastrointestinal tract which consists of Crohn’s disease (CD), ulcerative colitis (UC) and undifferentiated IBD. Epidemiology of IBD is changing worldwide, but a significant gap remains in the description of the IBD population in Latvia. The aim of the study was to determine the incidence and prevalence rates of IBD in Latvia in the period between 2013 and 2017. Retrospective analysis of reimbursed medicines claims for IBD diagnoses from the Latvian National Health Service database (NHS) was conducted for the period of 2012 to 2017. From CD patients, 53.7% were female and the area of residency strongly favoured urban areas vs rural districts of Latvia, 59.1% vs 40.9%, respectively. A similar demographic pattern was observed in UC patients, where 56.2% were female and 55.1% of the total UC population lived in urban areas. The overall age- and sex-adjusted incidence rates for CD and UC were 16.45 (CI95% [14.68, 18.21]) and 70.53 (CI95% [66.88, 74.19]) per 100 000 population, respectively, for the entire 2013–2017 period. The prevalence of CD and UC in 2012 was 12.4 and 54.8 cases per 100 000 persons, respectively, compared to 15.5 and 79.5 cases per 100 000 persons in CD and UC in 2017, resulting in a 25% increase in prevalence of CD and 41% increase in UC over the 5-year period. For the first time temporal trends in IBD incidence and prevalence as well as differences across age groups and gender over a five-year period are reported for Latvia.
The study represents a comprehensive retrospective morphological profiling of gastric carcinoma in order to reveal associations between certain tumour-infiltrating inflammatory cells and clinical and/or pathological parameters. Patients’ age and gender, the extent of local tumour spread (pT), presence of metastases in regional lymph nodes (pN), tumour grade (G) as well as type according to World Health Organisation (WHO) and Lauren classifications were assessed in 211 consecutive surgically resected gastric carcinomas. Tumour-infiltrating inflammatory cells including eosinophils, neutrophils and lymphocytes were counted within the cancer stroma in five randomly selected high-power fields representative of the tumour. Descriptive statistics, Mann–Whitney and Kruskal–Wallis tests were applied; p < 0.05 was considered significant. Higher number of stromal eosinophils was associated with absence of metastases in regional lymph nodes (pN0) and histological structure of adenocarcinoma by WHO classification (p = 0.005 and p = 0.002, respectively). Higher count of stromal neutrophils showed significant associations with younger age (less than 65 years), and intestinal type by Lauren classification (p = 0.029 and p = 0.007, respectively). The density of stromal lymphocytes lacked any statistically significant association with the evaluated clinical or morphological parameters. In conclusion, the current study highlights the links between certain innate immune system cells and morphological features of gastric carcinoma.